Narberth Cystic Fibrosis Run
9:00
AM @ Narberth Park
Name____________________________________________________
Age__________
Address________________________________________________Sex
M F (circle one)
City____________________________
_______State___________ Zip_____________
Email___________________________________________________________________
Waiver
& Release- Entrants Must Sign
In
consideration of this entry being accepted, I hereby, for myself, my heirs,
Executors and Administrators, waive and release any claims that I may have
against the Borough of Narberth, the Sponsors, their representatives,
successors, or assignees for any injuries that may be suffered by me in this
event. I also give permission for the use of my name and/or picture in any
newspaper, broadcast, or any other account of this event. I certify that I am
in physical condition for this event.
Signature_______________________________________________________________
*Parent
Signature________________________________________________________
*If
under 18 parent/guardian must sign
Please
sign and mail with check to:
Narberth
Cystic Fibrosis Run
P.O.
Box 752
Narberth PA 19072
Take A Breather Foundation Event
www.TakeABreather.net